MEDICARE: SUPPORT OUR STUDENTS FUTURE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	106S00000X	Behavior Technician
2	111N00000X	Chiropractor
3	111NN1001X	Nutrition Chiropractor
4	111NP0017X	Pediatric Chiropractor
5	133NN1002X	Nutrition Education Nutritionist
6	172V00000X	Community Health Worker
7	222Q00000X	Developmental Therapist
8	374U00000X	Home Health Aide
9	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1558298828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPPORT OUR STUDENTS FUTURE

Provider Business Mailing Address
First Line	:	6595 ROSWELL ROAD
Second Line	:	STE G PMB5332
City	:	ATLANTA
State	:	GA
Zip	:	30328-3152
Country	:	US
Telephone Number	:	404-913-9709
Fax Number	:

Provider Business Practice Location Address
First Line	:	6595 ROSWELL ROAD
Second Line	:	STE G PMB5332
City	:	ATLANTA
State	:	GA
Zip	:	30328-3152
Country	:	US
Telephone Number	:	404-913-9709
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JAINEA WILLIAMS
Credential	:
Telephone Number	:	404-913-9709

Provider Enumeration Date	:	05/08/2026
Last Update Date	:	05/08/2026

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